Nurse work engagement impacts job outcome and nurse-assessed quality of care: model testing with nurse practice environment and nurse work characteristics as predictors

Effect of the practice environment of nurses on job outcomes and safety climate

Objective:

to propose and analyze a theoretical model to measure the effect of nurses’ perceptions about the practice environment on safety climate, job satisfaction, intention to stay employed and in the profession, and burnout syndrome.

Method:

correlational study with probabilistic sample of 465 nurses. In the theoretical model, the dimensions of the nursing practice environment were considered as independent variables and job satisfaction, safety climate, intention to stay employed and in the profession, and burnout were considered the outcome variables. Structural Equation Modeling was the method used in the analysis.

Results:

small adjustments were made in the model and the dimensions of practice environment predicted job satisfaction (R² = 43%), safety climate (R² = 42%) and burnout (R² = 36%), as well as the intention to stay in the job (R² = 22%) and in the profession (R² = 17%).

Conclusion:

the practice environment showed a strong impact on job satisfaction, safety climate and burnout, with a moderate impact on the intention to stay in the institution and in the profession. The findings can be used to manage care in health institutions, focusing on promoting nurse retention and improving the safety climate.

Staff empowerment and engagement in a magnet® recognized and joint commission international accredited academic centre in Belgium: a cross-sectional survey

Background

A substantial number of studies linked aspects of a balanced, healthy and supportive nurse practice environment with quality and patient safety. To what extent balanced work characteristics such as social capital, decision latitude and workload are relevant for all staff engaged in patient care including healthcare and medical staff in a Magnet Recognized and Joint Commission International accredited academic centre is unclear. The study aim is to investigate associations between work characteristics such as social capital, decision latitude and workload, work engagement and feelings of burnout as explanatory variables and job satisfaction, turnover intentions and perceived quality of care as dependent variables in a study population of nursing, healthcare and medical staff taken in account generation differences.

Methods

Hierarchical regression analysis estimated strength of associations with demographic characteristics (block-1), professional category (block-2), work characteristics (block-3) and work engagement or burnout dimensions (block-4) as explanatory variables of job satisfaction and turnover intention and quality of care as outcome variables.

Results

The study confirmed and extended previous study findings demonstrating positive impact on staff’ job outcomes and assessed quality of care by balanced work characteristics such as social capital, decision latitude and workload in nursing staff (N = 864), healthcare staff (N = 131) and medical staff (N = 241). Generational characteristics and professional category were associated with turnover intentions and less favorable assessed quality of care, respectively. Explained variances of studied models ranged from 14.4 to 45.7%.

Conclusion

Engaging and committing staff to promote excellent patient outcomes in daily interdisciplinary practice works through clear frameworks, methods and resources supported by governance and policy structure that makes outcomes visible and accountable.

Quality of work life and self-care in nursing staff with high emotional demand

OBJECTIVE

To explore the variables related to the quality of work life and the self-care of nursing professionals working with high emotional demand.

METHOD

Qualitative, according to the constructivist paradigm. It combines the phenomenological-hermeneutic/interpretative method with the use of semi-structured interviews. Information was analyzed with Maxqda 11. Interviews included professionals from the Valencian healthcare system, with typical profiles of nurses working in surgical units, emergencies, oncology, home care, and cooperation.

RESULTS

Organizational factors were reported as a barrier to self-care, affecting healthcare activity. Working with patients was highlighted as a protective factor, based on the satisfaction derived from helping in situations of serious illness and suffering. The quality of work life manifested was assessed as not being what they would desire and deficient. The factors that affected the professionals most were the type of working day and work schedules (shifts, nights, holidays, on call...). The physical, mental and social dimensions of self-care can attenuate the negative effects of this situation.

CONCLUSIONS

It is necessary to examine in depth the construct of self-care, to counteract emotionally stressful problems and situations, to propose intervention strategies, training plans and greater involvement of health institutions in the improvement of nurses' quality of work life.

Organizational Factors and Burnout of Perioperative Nurses

BACKGROUND

Knowing the organizational factors that predict burnout in perioperative nurses is paramount for improving the care of patients and promoting nurses' psychosocial well-being and health.

OBJECTIVE

To determine the influence of organizational factors of the perioperative nurse's work environment on the three burnout dimensions: emotional exhaustion, despersonalization, and personal accomplishment.

METHOD

A cross-sectional study was conducted among 136 nurses in a perioperative care unit at a university hospital in Barcelona, Spain. Data were collected using a demographic data form, and the Spanish versions of the Practice Environment Scale of the Nursing Work Index and Maslach Burnout Inventory.

RESULTS

Findings showed emotional exhaustion in 43% (56) of nurses, depersonalization in 21% (28), and reduced personal accomplisment in 53% (69). The degree of general burnout was moderate.The work environment was considered unfavourable as only one factor of five was favourable (Nursing foundations of quality care). Multiple regression analyses showed three organizational factors were associated with all three dimensions of burnout: "Nurse manager ability, leadership, and support of nurses"; "Staffing and resources adequacy"; and "Nursing foundations of quality care".

CONCLUSIONS

In this study three organizational factors played a significant role in predicting burnout among perioperative nurses. We recommend hospital management implement policies to improve these organizational factors. Promoting positive leadership styles, providing necessary resources, and creating a positive climate in the work environment could increase psychosocial wellbeing and decrease burnout among perioperative nurses.

Ambiente da prática de enfermagem em unidades de terapia intensiva

Resumo Objetivo Analisar o ambiente da prática de enfermagem em unidades de terapia intensiva. Métodos Estudo descritivo, de abordagem quantitativa, realizado com 209 profissionais de enfermagem de três hospitais de ensino brasileiros. O ambiente da prática de enfermagem foi avaliado através da Practice Environment Scale. Os dados foram analisados descritivamente, assumindo nível de significância de 5% (p<0,05). O coeficiente Alfa de Cronbach foi utilizado para examinar a consistência interna dos construtos. Resultados Os profissionais de enfermagem consideraram desfavoráveis quatro das cinco dimensões do ambiente da prática profissional: participação dos enfermeiros na discussão dos assuntos hospitalares; fundamentos de enfermagem voltados para a qualidade do cuidado, habilidade, liderança e suporte dos coordenadores/supervisores de enfermagem aos enfermeiros/equipe de enfermagem; e adequação da equipe e de recursos. Apenas a dimensão relações colegiais entre profissionais de enfermagem e médicos apresentou avaliação positiva. Enfermeiros reconheceram mais fortemente atributos desfavoráveis no ambiente de prática do que técnicos de enfermagem. Conclusão O ambiente mostrou-se desfavorável para a prática dos profissionais de enfermagem. Esforços são necessários para tornar o ambiente de prática mais atrativo aos profissionais de enfermagem, e assim estimular melhorias na qualidade e na segurança da assistência prestada.

Defining the critical role of nurses in diagnostic error prevention: a conceptual framework and a call to action

Nurses have always been involved in the diagnostic process, but there remains a pervasive view across physicians, nurses, and allied health professionals that medical diagnosis is solely a physician responsibility. There is an urgent need to adjust this view and for nurses to take part in leading efforts addressing diagnostic errors. The purpose of this article is to define a framework for nursing engagement in the diagnostic process that can serve as a catalyst for nurses to engage in eliminating preventable harms from diagnostic error. We offer a conceptual model to formalize and expand nurses’ engagement in the diagnostic process through education, maximize effectiveness of interprofessional teamwork and communication through culture change, and leverage the nursing mission to empower patients to become active members of the diagnostic team. We describe the primary barriers, including culture, education, operations, and regulations, to nurses participating as full, equal members of the diagnostic team, and illustrate our approach to addressing these barriers. Nurses already play a major role in diagnosis and increasingly take ownership of this role, removing barriers will strengthen nurses’ ability to be equal, integral diagnostic team members. This model should serve as a foundation for increasing the role of the nurse in the diagnostic process, and calling nurses to take action in leading efforts to reduce diagnostic error.

Antecedents and outcomes of nurses' rest break organization: A scoping review

OBJECTIVES

To prevent an accumulation of strain during work and to reduce error risk, many countries have made rest breaks mandatory. In the nursing literature, insufficient rest break organization is often reported. However, the outcomes of nurses' rest break organization and its anteceding factors are less clear.

DATA SOURCES

We searched for academic literature on nurses' rest break organization in electronic databases (PubMed, Medline, PsycArticles, PsycINFO, CINAHL).

REVIEW METHODS

Our search yielded 93 potentially relevant articles published between 01/1990 and 04/2016. The final sample in our scoping review consisted of 36 publications and included data from 35 independent and international study samples and two reviews.

RESULTS

Several studies reported a high prevalence of missed, interrupted, or delayed rest breaks in nursing. Nurses' rest breaks often related to better physical and mental well-being but did not affect motivational outcomes and performance systematically. Results on the effects of napping breaks were inconsistent. Rest break activities and high quality rest break areas are further factors that relieve nurses from job demands and can be helpful in coping with them. Several study results indicated that temporal and quantitative work demands, job resources, and individual characteristics influence rest break organization. However, most of these findings stem from studies that do not allow causal conclusions to be drawn.

CONCLUSIONS

Well-designed rest breaks influence nurses' occupational well-being and behavior positively. However, the mechanisms and moderating break-, work-, and person-related factors involved in producing these effects are not well understood today. Thus, further theory building and stronger empirical data are needed.

Psychometric assessment of a scale to measure bonding workplace social capital

OBJECTIVES

Workplace social capital (WSC) has attracted increasing attention as an organizational and psychosocial factor related to worker health. This study aimed to assess the psychometric properties of a newly developed WSC scale for use in work environments, where bonding social capital is important.

METHODS

We assessed the psychometric properties of a newly developed 6-item scale to measure bonding WSC using two data sources. Participants were 1,650 randomly selected workers who completed an online survey. Exploratory factor analyses were conducted. We examined the item-item and item-total correlations, internal consistency, and associations between scale scores and a previous 8-item measure of WSC. We evaluated test-retest reliability by repeating the survey with 900 of the respondents 2 weeks later. The overall scale reliability was quantified by an intraclass coefficient and the standard error of measurement. We evaluated convergent validity by examining the association with several relevant workplace psychosocial factors using a dataset from workers employed by an electrical components company (n = 2,975).

RESULTS

The scale was unidimensional. The item-item and item-total correlations ranged from 0.52 to 0.78 (p < 0.01) and from 0.79 to 0.89 (p < 0.01), respectively. Internal consistency was good (Cronbach's α coefficient: 0.93). The correlation with the 8-item scale indicated high criterion validity (r = 0.81) and the scale showed high test-retest reliability (r = 0.74, p < 0.01). The intraclass coefficient and standard error of measurement were 0.74 (95% confidence intervals: 0.71-0.77) and 4.04 (95% confidence intervals: 1.86-6.20), respectively. Correlations with relevant workplace psychosocial factors showed convergent validity.

CONCLUSIONS

The results confirmed that the newly developed WSC scale has adequate psychometric properties.

‘You just can’t do it all’: a secondary analysis of nurses' perceptions of teamwork, staffing and workload

The purpose of this study was to re-examine data to explore connections between nurses’ perceptions of teamwork, staffing and workload, focusing on salient aspects and connections, from the nurses’ perspective. Insufficient staffing levels and imbalanced workload distributions are prominent challenges in contemporary healthcare which can cause increased incident reports, medical errors and lower patient satisfaction. Using a novel form of secondary analysis – an original qualitative analysis followed by a quantification of the qualitative data, we found themes of teamwork, staffing and workload were interrelated in the data. When facing workload challenges created by understaffing, participants directly attributed their units’ ability to meet the needs of patient care to levels of teamwork on the unit. We suggest that teamwork in healthcare needs targeted organisational support. In other words, healthcare organisations must systematically approach and monitor the status of nursing teamwork, e.g. implement programmes to develop it as needed, particularly when faced with staffing and workload challenges. Healthcare leaders can learn from and the healthcare delivery workplace can be shaped by listening to teamwork perceptions of nurses.

Balancing nurses' workload in hospital wards: study protocol of developing a method to manage workload

INTRODUCTION

Hospitals pursue different goals at the same time: excellent service to their patients, good quality care, operational excellence, retaining employees. This requires a good balance between patient needs and nursing staff. One way to ensure a proper fit between patient needs and nursing staff is to work with a workload management method. In our view, a nursing workload management method needs to have the following characteristics: easy to interpret; limited additional registration; applicable to different types of hospital wards; supported by nurses; covers all activities of nurses and suitable for prospective planning of nursing staff. At present, no such method is available.

METHODS/ANALYSIS

The research follows several steps to come to a workload management method for staff nurses. First, a list of patient characteristics relevant to care time will be composed by performing a Delphi study among staff nurses. Next, a time study of nurses' activities will be carried out. The 2 can be combined to estimate care time per patient group and estimate the time nurses spend on non-patient-related activities. These 2 estimates can be combined and compared with available nursing resources: this gives an estimate of nurses' workload. The research will take place in an academic hospital in the Netherlands. 6 surgical wards will be included, capacity 15-30 beds.

ETHICAL CONSIDERATIONS

The study protocol was submitted to the Medical Ethical Review Board of the University Medical Center (UMC) Utrecht and received a positive advice, protocol number 14-165/C.

DISCUSSION

This method will be developed in close cooperation with staff nurses and ward management. The strong involvement of the end users will contribute to a broader support of the results. The method we will develop may also be useful for planning purposes; this is a strong advantage compared with existing methods, which tend to focus on retrospective analysis.

How Changes in Psychosocial Job Characteristics Impact Burnout in Nurses: A Longitudinal Analysis

Aims: The main aim of this longitudinal study was to test the Job Demand-Control-Support (JDCS) model and to analyze whether changes in psychosocial job characteristics are related to (changes in) burnout.

Background: Previous studies on the effects of JDCS variables on burnout dimensions have indicated that the iso-strain hypothesis (i.e., high job demands, low control, and low support additively predict high stress reactions) and the buffer hypotheses (i.e., high job control and/or social support is expected to moderate the negative impact of high demands on stress reactions) have hardly been examined concurrently in a longitudinal design; and that the effects of changes of psychosocial job variables on burnout dimensions have hardly been analyzed.

Design: This two wave study was carried out over a period of 14 months in a sample of 217 Italian nurses.

Method: Hierarchical regression analyses were used to test the cross lagged main and interactive effects of JDCS variables, and to analyse the across-time effects of changes in JDCS dimensions on burnout variables.

Results: The Time 1 job characteristics explained 2–8% of the variance in the Time 2 burnout dimensions, but no support for the additive, or the buffer hypothesis of the JDCS model was found. Changes in job characteristics explained an additional 3–20% of variance in the Time 2 burnout dimensions. Specifically, high levels of emotional exhaustion at Time 2 were explained by high levels of social support at Time 1, and unfavorable changes in demands, control, and support over time; high depersonalization at Time 2 was explained by high social support at time 1 and by an increase in demands over time; and high personal accomplishment at Time 2 was predicted by high demands, high control, interactive effect demands × control × social support, at Time 1, and by a decrease in demands over time. No reversed effects of burnout on work characteristics have been found.

Conclusion: Our findings suggest that the work environment is subject to changes: the majority of employees experienced considerable changes in all job conditions over time. These changes impacted employee burnout. Limitations and implications of the study are discussed.

Burnout Syndrome Among Health Care Students: The Role of Type D Personality

The aim of this study was to examine the effect of Type D personality, along with other personality traits (resilience and sense of coherence), on burnout syndrome and its counterpart, engagement, among students of nursing, midwifery, and psychology. A cross-sectional study was conducted on 97 university students (91.9% females; M age = 20.2 ± 1.49 years). A Type D personality subscale, School Burnout Inventory, Utrecht Work Engagement Scale, Sense of Coherence Questionnaire, and Baruth Protective Factor Inventory were used. Linear regression models, Student's t test, and Pearson's correlation analysis were employed. Negative affectivity, a dimension of Type D personality, was a significant personality predictor for burnout syndrome (β = .54; 95% CI = [0.33, 1.01]). The only significant personality predictor of engagement was a sense of coherence. Students who were identified as having Type D personality characteristics scored significantly higher on the burnout syndrome questionnaire ( t = -2.58, p < .01). In health care professions, personality predictors should be addressed to prevent burnout.

Relationships of job demand, job control, and social support on intention to leave and depressive symptoms in Japanese nurses

This study aims to elucidate the relationships among the factors of the demand-control-support model (DCS) on the intention to leave a hospital job and depressive symptoms. Participants included 1,063 nurses. Job demand, job control, and support from supervisors were found to be significantly related to both the intention to leave and depressive symptoms. Based on the odds ratios per 1 SD change in the DCS factors, low support from supervisors was found to be most related to the intention to leave, and low job control was found to be most related to depressive symptoms. In models that did not include "job demand" as an independent variable, 60-h working weeks were found to have a significantly higher odds ratio for depressive symptoms. Support from supervisors is more important in preventing intention to leave and depressive symptoms among nurses than is support from co-workers. Improving job control and avoiding long working hours may be important to prevent depressive symptoms.

Occupational coping self-efficacy explains distress and well-being in nurses beyond psychosocial job characteristics

AIM

The main purpose of the present study was to extend the Job Demand Control Support (JDCS) model analyzing the direct and interactive role of occupational coping self-efficacy (OCSE) beliefs.

BACKGROUND

OCSE refers to an individual's beliefs about their ability to cope with occupational stressors. The interplay between occupational stressors, job resources, and self-efficacy beliefs is poorly investigated. The present research attempts to address this gap.

DESIGN

Cross-sectional survey.

METHOD

Questionnaire data from 1479 nurses (65% response) were analyzed. Hierarchical regression analyses were used to test the direct and moderating role of OCSE in conjunction with job demands (i.e., time pressure), and two job resources: job control (i.e., decision latitude and skill discretion) and social support (i.e., supervisor support and coworker support) in predicting psychological distress and well-being.

RESULTS

Our findings indicated that high demands, low job control, and low social support additively predicted the distress/well-being outcomes (job satisfaction, emotional exhaustion, depersonalization, psychological distress, and somatic complaints). Beyond the main effects, no significant interactive effects of demands, control, and support were found. OCSE accounted for an additional 1-4% of the variance in the outcomes, after controlling for the JDCS variables. In addition, the results indicate that OCSE buffers the association between low job control and the distress dimensions emotional exhaustion, depersonalization, and psychological distress. Low control was detrimental only for nurses with low OCSE.

CONCLUSION

Our results suggest expanding the JDCS model incorporating individual characteristics such as OCSE beliefs, for predicting psychological distress and well-being. Limitations of the study and practical implications are discussed.